Opiate of the Masses

How the free market created the addiction crisis

Black tar heroin

It took me going on paternity leave to finally read a book that, given the focus of much of my reporting, I should have read a long time ago: San Quinones’ Dreamland. I had already read Quinones’ more recent book, The Least of Us, which is about the scourge of fentanyl and methamphetamines that is presently tearing a hole through the social fabric of our country. Since meth and fentanyl dominate the market for street drugs at the moment, I thought that Dreamland, which documents how the widespread use of legally prescribed opiate painkillers led to an epidemic of heroin addiction across the country, was less urgent to read (heroin barely exists in the drug supply today). That was a dumb assumption, and not just because Dreamland is a far better book.

This may be obvious, but you can’t really understand the fentanyl crisis without knowing the history of the heroin crisis that preceded it, for the simple reason that fentanyl has flooded American city streets only because there were already so many heroin addicts to sell to. Fentanyl is just a more powerful, and thus cheaper, synthetic version of heroin; getting a user to switch is about as hard as getting an Apple customer to update their iPhone. Both drugs found their market from the same event: the introduction and aggressive marketing of OxyContin. For that reason alone, Dreamland is indispensable.

Even more valuable, however, is Quinones’ thesis in Dreamland that there is a more fundamental reason for the opiate epidemic than Purdue Pharma’s deadly innovation. OxyContin was released onto the market in 1996, just five years after the collapse of the Soviet Union. The End of History and the Last Man, Francis Fukuyama’s triumphalist story of liberal democracy’s conquest of civilization as the final stage of human development, was four years old. America was the sole superpower in a unipolar New World Order, and set about in the 1990s to remake the world in its image.

American businessmen, intellectuals, diplomats, and politicians constructed a new international system based on the fantasy that the marketplace was the primal and organic expression of all human relations, and that government intervention in the self-regulating, global free market was a perversion of this natural order. Indoctrinated into this economic orthodoxy, Congress passed NAFTA, President Clinton championed the creation of the World Trade Organization, and the United States offered China Permanent Normal Trade Relations. American industry rushed to move as much of its manufacturing base as physically possible out of the United States and into poor, developing nations with cheap workers and flimsy environmental rules.

The story Quinones tells in Dreamland unfolds all over the country, but it is anchored in Portsmouth, Ohio, a city of less than 20,000 across the Ohio River from Kentucky and an hour’s drive from West Virginia. Portsmouth was once home to a thriving shoemaking industry, but one after another, the factories closed with nothing to replace them. With this loss of jobs to the global free market came the loss of community, as the institutions of civic life closed their doors, or, in the case of a once-thriving swimming pool called Dreamland, was bulldozed and turned into a strip mall parking lot.